Psoriasis medical therapy: Difference between revisions

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==Overview==
==Overview==
The mainstay of therapy for psoriasis is [[topical]] agents applied directly onto the [[lesions]]. [[Topical]] agents include [[Corticosteroid|corticosteroids]], [[vitamin D]] analogues, [[tar]], [[anthralin]], [[tazarotene]], [[Calcineurin inhibitor|calcineurin inhibitors]], and [[aloe vera]] extracts. Systemic therapy may also be used, which includes [[Immunosuppresive drug|immunosupressants]] to counteract the disease process.
The mainstay of therapy for psoriasis consists of the application of [[topical]] agents directly onto the [[lesions]]. [[Topical]] agents include [[Corticosteroid|corticosteroids]], [[vitamin D]] analogues, [[tar]], [[anthralin]], [[tazarotene]], [[Calcineurin inhibitor|calcineurin inhibitors]], and [[aloe vera]] extracts. Systemic therapy may also be used, including [[Immunosuppresive drug|immunosupressants]] to counteract the progression of the disease.


==Medical Therapy==
==Medical Therapy==
Therapies are administered according to disease severity and assessed by the Psoriasis Area and Severity Index (PASI, ranging from 0 to 72), which takes into account appearance and extension of the [[lesions]]. Interventions in medical therapy for psoriasis comprise:
Therapies are administered according to disease severity as assessed by the Psoriasis Area and Severity Index (PASI, ranging from 0 to 72), which takes into account appearance and extension of the [[lesions]]. Interventions in medical therapy for psoriasis include:
* [[Topical]] therapy
* [[Topical]] therapy
* [[Phototherapy]]
* [[Phototherapy]]
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=== Topical therapy ===
=== Topical therapy ===
* Medicated creams and ointments applied directly to psoriatic [[lesions]] can help decrease inflammation, remove built-up scale, reduce skin turn over, and clear affected skin of [[plaques]].<ref name="pmid16916825">{{cite journal |vauthors=Smith CH, Barker JN |title=Psoriasis and its management |journal=BMJ |volume=333 |issue=7564 |pages=380–4 |year=2006 |pmid=16916825 |pmc=1550454 |doi=10.1136/bmj.333.7564.380 |url=}}</ref>  
* Medicated creams and ointments applied directly to psoriatic [[lesions]] can help decrease inflammation, remove built-up scale, reduce skin turnover, and clear affected skin of [[plaques]].<ref name="pmid16916825">{{cite journal |vauthors=Smith CH, Barker JN |title=Psoriasis and its management |journal=BMJ |volume=333 |issue=7564 |pages=380–4 |year=2006 |pmid=16916825 |pmc=1550454 |doi=10.1136/bmj.333.7564.380 |url=}}</ref>  
* Approved drugs that can be used as topical therapy for acute management of psoriasis include:<ref name="pmid10753146">{{cite journal |vauthors=Ashcroft DM, Po AL, Williams HC, Griffiths CE |title=Systematic review of comparative efficacy and tolerability of calcipotriol in treating chronic plaque psoriasis |journal=BMJ |volume=320 |issue=7240 |pages=963–7 |year=2000 |pmid=10753146 |pmc=27334 |doi= |url=}}</ref><ref name="pmid8765459">{{cite journal |vauthors=Syed TA, Ahmad SA, Holt AH, Ahmad SA, Ahmad SH, Afzal M |title=Management of psoriasis with Aloe vera extract in a hydrophilic cream: a placebo-controlled, double-blind study |journal=Trop. Med. Int. Health |volume=1 |issue=4 |pages=505–9 |year=1996 |pmid=8765459 |doi= |url=}}</ref><ref name="pmid19445765">{{cite journal |vauthors=Naldi L, Rzany B |title=Psoriasis (chronic plaque) |journal=BMJ Clin Evid |volume=2009 |issue= |pages= |year=2009 |pmid=19445765 |pmc=2907770 |doi= |url=}}</ref><ref name="pmid1451289">{{cite journal |vauthors=Escobar SO, Achenbach R, Iannantuono R, Torem V |title=Topical fish oil in psoriasis--a controlled and blind study |journal=Clin. Exp. Dermatol. |volume=17 |issue=3 |pages=159–62 |year=1992 |pmid=1451289 |doi= |url=}}</ref><ref name="pmid20599292">{{cite journal |vauthors=Levine D, Even-Chen Z, Lipets I, Pritulo OA, Svyatenko TV, Andrashko Y, Lebwohl M, Gottlieb A |title=Pilot, multicenter, double-blind, randomized placebo-controlled bilateral comparative study of a combination of calcipotriene and nicotinamide for the treatment of psoriasis |journal=J. Am. Acad. Dermatol. |volume=63 |issue=5 |pages=775–81 |year=2010 |pmid=20599292 |doi=10.1016/j.jaad.2009.10.016 |url=}}</ref>
* Approved drugs that can be used as topical therapy for acute management of psoriasis include:<ref name="pmid10753146">{{cite journal |vauthors=Ashcroft DM, Po AL, Williams HC, Griffiths CE |title=Systematic review of comparative efficacy and tolerability of calcipotriol in treating chronic plaque psoriasis |journal=BMJ |volume=320 |issue=7240 |pages=963–7 |year=2000 |pmid=10753146 |pmc=27334 |doi= |url=}}</ref><ref name="pmid8765459">{{cite journal |vauthors=Syed TA, Ahmad SA, Holt AH, Ahmad SA, Ahmad SH, Afzal M |title=Management of psoriasis with Aloe vera extract in a hydrophilic cream: a placebo-controlled, double-blind study |journal=Trop. Med. Int. Health |volume=1 |issue=4 |pages=505–9 |year=1996 |pmid=8765459 |doi= |url=}}</ref><ref name="pmid19445765">{{cite journal |vauthors=Naldi L, Rzany B |title=Psoriasis (chronic plaque) |journal=BMJ Clin Evid |volume=2009 |issue= |pages= |year=2009 |pmid=19445765 |pmc=2907770 |doi= |url=}}</ref><ref name="pmid1451289">{{cite journal |vauthors=Escobar SO, Achenbach R, Iannantuono R, Torem V |title=Topical fish oil in psoriasis--a controlled and blind study |journal=Clin. Exp. Dermatol. |volume=17 |issue=3 |pages=159–62 |year=1992 |pmid=1451289 |doi= |url=}}</ref><ref name="pmid20599292">{{cite journal |vauthors=Levine D, Even-Chen Z, Lipets I, Pritulo OA, Svyatenko TV, Andrashko Y, Lebwohl M, Gottlieb A |title=Pilot, multicenter, double-blind, randomized placebo-controlled bilateral comparative study of a combination of calcipotriene and nicotinamide for the treatment of psoriasis |journal=J. Am. Acad. Dermatol. |volume=63 |issue=5 |pages=775–81 |year=2010 |pmid=20599292 |doi=10.1016/j.jaad.2009.10.016 |url=}}</ref>
** [[Corticosteroid|Corticosteroids]]
** [[Corticosteroid|Corticosteroids]]
** [[Vitamin D]] analogues ([[calcipotriol]])
** [[Vitamin D]] analogues ([[calcipotriol]])
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** Combination of [[nicotinamide]] and [[calcipotriene]] 
** Combination of [[nicotinamide]] and [[calcipotriene]] 


* Combined treatment with [[vitamin D]]/[[corticosteroid]] on either the body or the scalp has significantly better outcomes than [[vitamin D]] alone.<ref name="urlTopical treatments for chronic plaque psoriasis - Mason - 2013 - The Cochrane Library - Wiley Online Library">{{cite web |url=http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005028.pub3/full |title=Topical treatments for chronic plaque psoriasis - Mason - 2013 - The Cochrane Library - Wiley Online Library |format= |work= |accessdate=}}</ref>
* Combined treatment with [[vitamin D]]/[[corticosteroid]] on either the body or the scalp generates significantly better outcomes than [[vitamin D]] alone.<ref name="urlTopical treatments for chronic plaque psoriasis - Mason - 2013 - The Cochrane Library - Wiley Online Library">{{cite web |url=http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005028.pub3/full |title=Topical treatments for chronic plaque psoriasis - Mason - 2013 - The Cochrane Library - Wiley Online Library |format= |work= |accessdate=}}</ref>


* The disadvantages of topical agents are that they can often irritate normal skin, can be time consuming and awkward to apply, cannot be used for long periods, can stain clothing, or can have a strong odor. As a result, it is sometimes difficult for people to maintain the regular application of these medications.  
* The disadvantages of topical agents are that they can often irritate normal skin, can be time consuming and awkward to apply, cannot be used for long periods, can stain clothing, and can have a strong odor. As a result, it is sometimes difficult for people to maintain the regular application of these medications.  
* Abrupt withdrawal of some topical agents, particularly [[Corticosteroid|corticosteroids]], can cause an aggressive recurrence of the condition.  
* Abrupt withdrawal from the use of some topical agents, particularly [[Corticosteroid|corticosteroids]], can cause an aggressive recurrence of the condition.  
* Some topical agents are used in conjunction with other therapies, especially [[phototherapy]].
* Some topical agents are commonly used in conjunction with other therapies, especially [[phototherapy]].


===Phototherapy===
===Phototherapy===
* It has long been recognized that daily, short, non-burning exposure to sunlight helped to clear or improve psoriasis.<ref name="pmid194457652">{{cite journal |vauthors=Naldi L, Rzany B |title=Psoriasis (chronic plaque) |journal=BMJ Clin Evid |volume=2009 |issue= |pages= |year=2009 |pmid=19445765 |pmc=2907770 |doi= |url=}}</ref>
* It has long been recognized that daily, short, non-burning exposure to sunlight can help clear or improve psoriasis.<ref name="pmid194457652">{{cite journal |vauthors=Naldi L, Rzany B |title=Psoriasis (chronic plaque) |journal=BMJ Clin Evid |volume=2009 |issue= |pages= |year=2009 |pmid=19445765 |pmc=2907770 |doi= |url=}}</ref>
* [[Niels Ryberg Finsen|Niels Finsen]] was the first [[physician]] to investigate the therapeutic effects of sunlight scientifically and to use sunlight in clinical practice. This became known as [[phototherapy]].
* [[Niels Ryberg Finsen|Niels Finsen]] was the first [[physician]] to investigate the therapeutic effects of sunlight scientifically and to use sunlight in clinical practice. This became known as [[phototherapy]].


* The narrow band part of the [[UVB radiation|UVB]] spectrum (311 to 312 nm) is most helpful for psoriasis. Exposure to [[UVB radiation|UVB]] several times per week over several weeks can help people attain a [[Remission (medicine)|remission]] from psoriasis.
* The narrow band part of the [[UVB radiation|UVB]] spectrum (311 to 312 nm) is most helpful for the management of psoriasis. Exposure to [[UVB radiation|UVB]] several times per week over several weeks can facilitate [[Remission (medicine)|remission]] from psoriasis.


* [[Ultraviolet light]] treatment is frequently combined with [[topical]] ([[coal tar]], [[calcipotriol]]) or systemic treatment ([[Retinoid|retinoids)]] as there is a synergy in their combination.  
* [[Ultraviolet light]] treatment is frequently combined with [[topical]] ([[coal tar]], [[calcipotriol]]) or systemic treatment ([[Retinoid|retinoids)]].  
* The Ingram regime involves [[UVB radiation|UVB]] and the application of [[anthralin]] paste.  
* The Ingram regime involves [[UVB radiation|UVB]] and the application of [[anthralin]] paste.  
* The Goeckerman regime combines [[coal tar]] ointment with [[UVB radiation|UVB]].
* The Goeckerman regime combines [[coal tar]] ointment with [[UVB radiation|UVB]].


=== Systemic therapy ===
=== Systemic therapy ===
The following drugs may be used for the treatment of psoriasis:<ref name="pmid19932926">{{cite journal |vauthors=Rosmarin DM, Lebwohl M, Elewski BE, Gottlieb AB |title=Cyclosporine and psoriasis: 2008 National Psoriasis Foundation Consensus Conference |journal=J. Am. Acad. Dermatol. |volume=62 |issue=5 |pages=838–53 |year=2010 |pmid=19932926 |doi=10.1016/j.jaad.2009.05.017 |url=}}</ref><ref name="pmid24131260">{{cite journal |vauthors=Schmitt J, Rosumeck S, Thomaschewski G, Sporbeck B, Haufe E, Nast A |title=Efficacy and safety of systemic treatments for moderate-to-severe psoriasis: meta-analysis of randomized controlled trials |journal=Br. J. Dermatol. |volume=170 |issue=2 |pages=274–303 |year=2014 |pmid=24131260 |doi=10.1111/bjd.12663 |url=}}</ref><ref name="pmid2907770">{{cite journal |vauthors=Nowicki B, Holthöfer H, Saraneva T, Rhen M, Väisänen-Rhen V, Korhonen TK |title=Location of adhesion sites for P-fimbriated and for 075X-positive Escherichia coli in the human kidney |journal=Microb. Pathog. |volume=1 |issue=2 |pages=169–80 |year=1986 |pmid=2907770 |doi= |url=}}</ref><ref name="pmid22250239">{{cite journal |vauthors=Hsu S, Papp KA, Lebwohl MG, Bagel J, Blauvelt A, Duffin KC, Crowley J, Eichenfield LF, Feldman SR, Fiorentino DF, Gelfand JM, Gottlieb AB, Jacobsen C, Kalb RE, Kavanaugh A, Korman NJ, Krueger GG, Michelon MA, Morison W, Ritchlin CT, Stein Gold L, Stone SP, Strober BE, Van Voorhees AS, Weiss SC, Wanat K, Bebo BF |title=Consensus guidelines for the management of plaque psoriasis |journal=Arch Dermatol |volume=148 |issue=1 |pages=95–102 |year=2012 |pmid=22250239 |doi=10.1001/archdermatol.2011.1410 |url=}}</ref><ref name="pmid18423260">{{cite journal |vauthors=Menter A, Gottlieb A, Feldman SR, Van Voorhees AS, Leonardi CL, Gordon KB, Lebwohl M, Koo JY, Elmets CA, Korman NJ, Beutner KR, Bhushan R |title=Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 1. Overview of psoriasis and guidelines of care for the treatment of psoriasis with biologics |journal=J. Am. Acad. Dermatol. |volume=58 |issue=5 |pages=826–50 |year=2008 |pmid=18423260 |doi=10.1016/j.jaad.2008.02.039 |url=}}</ref>  
The following drugs may be used in the treatment of psoriasis:<ref name="pmid19932926">{{cite journal |vauthors=Rosmarin DM, Lebwohl M, Elewski BE, Gottlieb AB |title=Cyclosporine and psoriasis: 2008 National Psoriasis Foundation Consensus Conference |journal=J. Am. Acad. Dermatol. |volume=62 |issue=5 |pages=838–53 |year=2010 |pmid=19932926 |doi=10.1016/j.jaad.2009.05.017 |url=}}</ref><ref name="pmid24131260">{{cite journal |vauthors=Schmitt J, Rosumeck S, Thomaschewski G, Sporbeck B, Haufe E, Nast A |title=Efficacy and safety of systemic treatments for moderate-to-severe psoriasis: meta-analysis of randomized controlled trials |journal=Br. J. Dermatol. |volume=170 |issue=2 |pages=274–303 |year=2014 |pmid=24131260 |doi=10.1111/bjd.12663 |url=}}</ref><ref name="pmid2907770">{{cite journal |vauthors=Nowicki B, Holthöfer H, Saraneva T, Rhen M, Väisänen-Rhen V, Korhonen TK |title=Location of adhesion sites for P-fimbriated and for 075X-positive Escherichia coli in the human kidney |journal=Microb. Pathog. |volume=1 |issue=2 |pages=169–80 |year=1986 |pmid=2907770 |doi= |url=}}</ref><ref name="pmid22250239">{{cite journal |vauthors=Hsu S, Papp KA, Lebwohl MG, Bagel J, Blauvelt A, Duffin KC, Crowley J, Eichenfield LF, Feldman SR, Fiorentino DF, Gelfand JM, Gottlieb AB, Jacobsen C, Kalb RE, Kavanaugh A, Korman NJ, Krueger GG, Michelon MA, Morison W, Ritchlin CT, Stein Gold L, Stone SP, Strober BE, Van Voorhees AS, Weiss SC, Wanat K, Bebo BF |title=Consensus guidelines for the management of plaque psoriasis |journal=Arch Dermatol |volume=148 |issue=1 |pages=95–102 |year=2012 |pmid=22250239 |doi=10.1001/archdermatol.2011.1410 |url=}}</ref><ref name="pmid18423260">{{cite journal |vauthors=Menter A, Gottlieb A, Feldman SR, Van Voorhees AS, Leonardi CL, Gordon KB, Lebwohl M, Koo JY, Elmets CA, Korman NJ, Beutner KR, Bhushan R |title=Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 1. Overview of psoriasis and guidelines of care for the treatment of psoriasis with biologics |journal=J. Am. Acad. Dermatol. |volume=58 |issue=5 |pages=826–50 |year=2008 |pmid=18423260 |doi=10.1016/j.jaad.2008.02.039 |url=}}</ref>  
{| class="wikitable"
{| class="wikitable"
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Type of agent
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Type of agent
Line 184: Line 183:


=== Treatment of psoriatic arthritis ===
=== Treatment of psoriatic arthritis ===
The following drugs may be used for treatment of psoriatic arthritis:<ref name="pmid22207516">{{cite journal |vauthors=Day MS, Nam D, Goodman S, Su EP, Figgie M |title=Psoriatic arthritis |journal=J Am Acad Orthop Surg |volume=20 |issue=1 |pages=28–37 |year=2012 |pmid=22207516 |doi=10.5435/JAAOS-20-01-028 |url=}}</ref>
The following drugs may be used in the treatment of [[psoriatic arthritis]]:<ref name="pmid22207516">{{cite journal |vauthors=Day MS, Nam D, Goodman S, Su EP, Figgie M |title=Psoriatic arthritis |journal=J Am Acad Orthop Surg |volume=20 |issue=1 |pages=28–37 |year=2012 |pmid=22207516 |doi=10.5435/JAAOS-20-01-028 |url=}}</ref>
{| class="wikitable"
{| class="wikitable"
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Drug
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Drug
Line 205: Line 204:
* Unknown mechanism
* Unknown mechanism
|
|
* One third of patients have [[Gastrointestinal tract|gastrointestinal]] distress, [[Dizziness|dizziness]] or [[hepatotoxicity]]
* One-third of patients have [[Gastrointestinal tract|gastrointestinal]] distress, [[Dizziness|dizziness]], or [[hepatotoxicity]]
|-
|-
|[[Methotrexate|'''Methotrexate''']]
|[[Methotrexate|'''Methotrexate''']]
Line 223: Line 222:
* Inhibits [[pyrimidine synthesis]] via [[Dihydrofolate reductase|dihydrofolate dehydrogenase]] [[inhibition]]
* Inhibits [[pyrimidine synthesis]] via [[Dihydrofolate reductase|dihydrofolate dehydrogenase]] [[inhibition]]
|
|
* Effective for [[symptoms]] of [[arthritis]], cutaneous psoriasis and for [[Prevention (medical)|prevention]] of disability
* Effective for [[symptoms]] of [[arthritis]], cutaneous psoriasis, and for [[Prevention (medical)|prevention]] of disability
|-
|-
|'''[[Etanercept]]'''
|'''[[Etanercept]]'''
Line 233: Line 232:
|'''[[Infliximab]]'''  
|'''[[Infliximab]]'''  
|
|
* [[Chimeric protein|Chimeric monoclonal antibody]] that attaches to [[membrane]] bound and soluble [[Tumor necrosis factor-alpha|TNF-alpha]]
* [[Chimeric protein|Chimeric monoclonal antibody]] that attaches to [[membrane]]-bound and soluble [[Tumor necrosis factor-alpha|TNF-alpha]]
|
|
* Administered as [[intravenous infusion]]
* Administered as [[intravenous infusion]]
Line 245: Line 244:
|'''[[Alefacept]]'''
|'''[[Alefacept]]'''
|
|
* Human LFA-3/[[Immunoglobulin G|IgG]] fusion [[protein]] which attaches to [[CD2]] [[receptor]] on [[T cells]]
* Human LFA-3/[[Immunoglobulin G|IgG]] fusion [[protein]], which attaches to [[CD2]] [[receptor]] on [[T cells]]
|
|
* Combination with [[methotrexate]] for effective than [[monotherapy]]
* Combination with [[methotrexate]] for effective than [[monotherapy]]
Line 251: Line 250:
|'''[[Efalizumab]]'''
|'''[[Efalizumab]]'''
|
|
* Humanized monoclonal antibody directed against CD11a which disrupts [[T cell]] costimulatory LFA-1/ICAM-1 interaction
* Humanized monoclonal antibody directed against CD11a, which disrupts [[T cell]] costimulatory LFA-1/ICAM-1 interaction
|
|
* Associated with [[progressive multifocal leukoencephalopathy]] (PML)
* Associated with [[progressive multifocal leukoencephalopathy]] (PML)
Line 257: Line 256:
|'''[[Abatacept]]'''
|'''[[Abatacept]]'''
|
|
* [[Recombinant proteins|Recombinant]]<nowiki/>t human fusion [[protein]], binds [[CD80|CD80/]][[CD86|86]] and inhibits [[CD28]] [[receptor]] on [[T cell|T cells]]
* [[Recombinant proteins|Recombinant]]<nowiki/> human fusion [[protein]]; binds [[CD80|CD80/]][[CD86|86]] and inhibits [[CD28]] [[receptor]] on [[T cell|T cells]]
|
|
* May be used for psoriatic arthritis but not commonly employed as a therapy
* May be used for [[psoriatic arthritis]], but not commonly employed as a therapy
|}
|}


Revision as of 23:54, 8 August 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2]

Overview

The mainstay of therapy for psoriasis consists of the application of topical agents directly onto the lesions. Topical agents include corticosteroids, vitamin D analogues, tar, anthralin, tazarotene, calcineurin inhibitors, and aloe vera extracts. Systemic therapy may also be used, including immunosupressants to counteract the progression of the disease.

Medical Therapy

Therapies are administered according to disease severity as assessed by the Psoriasis Area and Severity Index (PASI, ranging from 0 to 72), which takes into account appearance and extension of the lesions. Interventions in medical therapy for psoriasis include:

Topical therapy

  • The disadvantages of topical agents are that they can often irritate normal skin, can be time consuming and awkward to apply, cannot be used for long periods, can stain clothing, and can have a strong odor. As a result, it is sometimes difficult for people to maintain the regular application of these medications.
  • Abrupt withdrawal from the use of some topical agents, particularly corticosteroids, can cause an aggressive recurrence of the condition.
  • Some topical agents are commonly used in conjunction with other therapies, especially phototherapy.

Phototherapy

  • It has long been recognized that daily, short, non-burning exposure to sunlight can help clear or improve psoriasis.[8]
  • Niels Finsen was the first physician to investigate the therapeutic effects of sunlight scientifically and to use sunlight in clinical practice. This became known as phototherapy.
  • The narrow band part of the UVB spectrum (311 to 312 nm) is most helpful for the management of psoriasis. Exposure to UVB several times per week over several weeks can facilitate remission from psoriasis.

Systemic therapy

The following drugs may be used in the treatment of psoriasis:[9][10][11][12][13]

Type of agent Mechanism of action Name Molecular target Formulation Administration route
Biologic Anti-metabolite Methotrexate DHFR NA Oral or IV
Anti-T cell Cyclosporine Cyclophilin NA Oral or IV
Alefacept CD2 Human LFA-3/IgG1 fusion protein IM or IV
Efalizumab CD11a Humanized IgG1 monoclonal antibody SC
Abatacept CTLA-4 Human CTLA4–Ig-IgG1 fusion protein SC or IV
Anticytokine Etanercept TNF Human TNF-R (p75)-lgG1 fusion protein SC
Infliximab TNF Mouse-human IgG1 chimeric monoclonal antibody IV
Adalimumab TNF Human IgG1 monoclonal antibody SC
Ustekinumab IL-2, IL-23 Human IgG1 monoclonal antibody SC
Briakinumab (discontinued in USA in 2011) IL-12, IL-23 Human IgG1 monoclonal antibody SC
Guselkumab IL-23p19 Human IgG1 monoclonal antibody SC
Brodalumab IL-17R Human IgG2 monoclonal antibody SC
Ixekizumab IL-17 Humanized IgG4 monoclonal antibody SC
Secukinumab IL-17 Human IgG1 monoclonal antibody SC or IV
Fezakinumab IL-22 Human IgG1 monoclonal antibody SC or IV
Small molecule PDE4 inhibitor Apremilast PDE4 NA Oral
JAK inhibitor Tofacitinib JAK1 and JAK3 NA Oral
Baricitinib JAK1 and JAK2 NA Oral
PKC inhibitor AEB071 PKC NA Oral
A3AR agonist CF101 A3AR NA Oral

DHFR: Dihydrofolate reductase

SC: Sub-cutaneous

IV: Intra-venous

IM: Intra-muscular

NA: Not Applicable

PDE4: Phosphodiesterase 4

JAK: Janus Kinase

PKC: Protein Kinase C

LFA: Lymphocyte function associated antigen

TNF: Tumor necrosis factor

Treatment of psoriatic arthritis

The following drugs may be used in the treatment of psoriatic arthritis:[14]

Drug Mechanism Comments
NSAIDs
Corticosteroids
Sulfasalazine
  • Unknown mechanism
Methotrexate
Cyclosporine
  • More often used for cutaneous psoriasis
Leflunomide
Etanercept
Infliximab
Adalimumab
Alefacept
Efalizumab
  • Humanized monoclonal antibody directed against CD11a, which disrupts T cell costimulatory LFA-1/ICAM-1 interaction
Abatacept

References

  1. ↑ Smith CH, Barker JN (2006). "Psoriasis and its management". BMJ. 333 (7564): 380–4. doi:10.1136/bmj.333.7564.380. PMC 1550454. PMID 16916825.
  2. ↑ Ashcroft DM, Po AL, Williams HC, Griffiths CE (2000). "Systematic review of comparative efficacy and tolerability of calcipotriol in treating chronic plaque psoriasis". BMJ. 320 (7240): 963–7. PMC 27334. PMID 10753146.
  3. ↑ Syed TA, Ahmad SA, Holt AH, Ahmad SA, Ahmad SH, Afzal M (1996). "Management of psoriasis with Aloe vera extract in a hydrophilic cream: a placebo-controlled, double-blind study". Trop. Med. Int. Health. 1 (4): 505–9. PMID 8765459.
  4. ↑ Naldi L, Rzany B (2009). "Psoriasis (chronic plaque)". BMJ Clin Evid. 2009. PMC 2907770. PMID 19445765.
  5. ↑ Escobar SO, Achenbach R, Iannantuono R, Torem V (1992). "Topical fish oil in psoriasis--a controlled and blind study". Clin. Exp. Dermatol. 17 (3): 159–62. PMID 1451289.
  6. ↑ Levine D, Even-Chen Z, Lipets I, Pritulo OA, Svyatenko TV, Andrashko Y, Lebwohl M, Gottlieb A (2010). "Pilot, multicenter, double-blind, randomized placebo-controlled bilateral comparative study of a combination of calcipotriene and nicotinamide for the treatment of psoriasis". J. Am. Acad. Dermatol. 63 (5): 775–81. doi:10.1016/j.jaad.2009.10.016. PMID 20599292.
  7. ↑ "Topical treatments for chronic plaque psoriasis - Mason - 2013 - The Cochrane Library - Wiley Online Library".
  8. ↑ Naldi L, Rzany B (2009). "Psoriasis (chronic plaque)". BMJ Clin Evid. 2009. PMC 2907770. PMID 19445765.
  9. ↑ Rosmarin DM, Lebwohl M, Elewski BE, Gottlieb AB (2010). "Cyclosporine and psoriasis: 2008 National Psoriasis Foundation Consensus Conference". J. Am. Acad. Dermatol. 62 (5): 838–53. doi:10.1016/j.jaad.2009.05.017. PMID 19932926.
  10. ↑ Schmitt J, Rosumeck S, Thomaschewski G, Sporbeck B, Haufe E, Nast A (2014). "Efficacy and safety of systemic treatments for moderate-to-severe psoriasis: meta-analysis of randomized controlled trials". Br. J. Dermatol. 170 (2): 274–303. doi:10.1111/bjd.12663. PMID 24131260.
  11. ↑ Nowicki B, Holthöfer H, Saraneva T, Rhen M, Väisänen-Rhen V, Korhonen TK (1986). "Location of adhesion sites for P-fimbriated and for 075X-positive Escherichia coli in the human kidney". Microb. Pathog. 1 (2): 169–80. PMID 2907770.
  12. ↑ Hsu S, Papp KA, Lebwohl MG, Bagel J, Blauvelt A, Duffin KC, Crowley J, Eichenfield LF, Feldman SR, Fiorentino DF, Gelfand JM, Gottlieb AB, Jacobsen C, Kalb RE, Kavanaugh A, Korman NJ, Krueger GG, Michelon MA, Morison W, Ritchlin CT, Stein Gold L, Stone SP, Strober BE, Van Voorhees AS, Weiss SC, Wanat K, Bebo BF (2012). "Consensus guidelines for the management of plaque psoriasis". Arch Dermatol. 148 (1): 95–102. doi:10.1001/archdermatol.2011.1410. PMID 22250239.
  13. ↑ Menter A, Gottlieb A, Feldman SR, Van Voorhees AS, Leonardi CL, Gordon KB, Lebwohl M, Koo JY, Elmets CA, Korman NJ, Beutner KR, Bhushan R (2008). "Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 1. Overview of psoriasis and guidelines of care for the treatment of psoriasis with biologics". J. Am. Acad. Dermatol. 58 (5): 826–50. doi:10.1016/j.jaad.2008.02.039. PMID 18423260.
  14. ↑ Day MS, Nam D, Goodman S, Su EP, Figgie M (2012). "Psoriatic arthritis". J Am Acad Orthop Surg. 20 (1): 28–37. doi:10.5435/JAAOS-20-01-028. PMID 22207516.

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